Permit • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00860
� DEVELOPMENT SERVICES DATE ISSUED: 11/2/2005
s= ` II I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 400 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT : JURISDICTION: TIG
Project Description: TI
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVCI FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC REALTY ASSOCIATES JOHANSEN ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 10948 SE VALLEY VIEW TERR
PORTLAND, OR 97224 CLACKAMAS, OR 97015 -000
Phone: 503 - 624 -6300 Phone: 503 - 698 -3417
FEES Reg #: LIC 51539
SUP 2053S
Description Date Amount ELE 3 -243C
[ELPRMT] ELC Permit 11/2/2005 $53.50
[TAX] 8% State Surcharge 11/2/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will . - :: • - in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspen.' . for more th -' 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules - - set forth in OA - •5 • I -00 • through OAR 952 - 001 -0100. You may obtain copies of the:".Lules or direct questions to OUNC at
503 -2 .16 -6699 or 1 -800 -3 '-2344 1 /
Issue f . LI ■ iL_ _ Permittee Signat e: / / �- 9 r c,--(---
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: ` ' %::.i I a ll" r DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
From: Charlynn Leifsen 503 - 698 -2486 To: City of Tigard Date: 11/1/2005 Time: 3:17:28 PM Page 2 of 3
i t r i caJ1 Permi A le E � V E
P ttllt u► r►I 1. ► ■L: 0\1 .1
City of Tigard - K, :, 1r Pcmd No.: . is
13125 SW Hall Blvd., Tigard, OR 97223 NOV N 0 Plan Review
�� 00'g ...!
Phone: 503.639.4171 Fax: 503.598.1960 tither Petma:
Inspection Line: 503.639.4175 CITY OF F T I G i 4. J i ; dyBy _ p= for
Internet: www.ci.tigard.or.us BUIL DING Div � : ' - Notified/Method:
F41111 Supptemmhllnfosmatloo
- :;; +1 ' ? - .xF :k s[ u f'.....,
❑ New construction
IN Additiodaheration/replacement Please check all that apply: _.
❑ Demolition ❑Other: ❑Service over 225 amps, council ❑Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft ,
. r. ,a...�.:. , .r• 4 , .. . '; y '. r - , of 1 - and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ multi-family ❑Master builder El Outer;
a „- „ ti , j , ['Occupant load over 99 persons ❑Mrmufacdued structures or
=.:. 7 : ..,., --,� ❑Egressllight6lg plan RV park
Job no.: Job site address: 12909 SW 68th Pkwy, 400 ❑Heahtl-care facility ❑Other:
Submit sets of plans with any of the above.
City/State/ ZIP: The above are not applicable to temporary oonstrttction service.
Suite/bldg. /apt no Project name: �J iC _ .
DeKriptkos Qty. Fee. Toed
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax tnap/parcel no
' ' U s '-'1.-;.,---i`...,:`' r ren .v _ . r £ i energy, non - residential 75.00 2
Limited
n......rs" •� �:i_ '.i.. S-�? .., � ui i . z,`.. i2, %f ,ac. % ,:- r . j Each manufactured or modular
TI dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' 1 , r , r F, z ,�s 201 amps to 400 amps 106.85 2 • ` 401 amps to 600 amps 160.60 2
Name: k
u..: i. 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: , , o Fax: ( ) 200 amps or less 66.85 1 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
' e f a ° i 1 K "" A
Fee for branch circuits with
........ .. ;: a , .. � -, : 3 ,., , . , --«.:: service or feeder fee, each
Business name: Johansen Electric Inc. branch circuit 6.65 2
B. Fee for branch circuits
Contact name: Charlynn Leifsen without service or feeder fee, 1 46.85 46.85 2
Address: 10948 SE Valley View Terr. each branch circuit
Each add'I branch circuit 1 6.65 6.65 2
City/State/ZIP: Clackamas, OR 97015 Miscellaneous (service or feeder not included)
Phone: (503) 698 -3417 Fax: : (503) 698 -2486 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: johansenelect@msn.com Signal circuit(s) or limited-
; { ,ri�E N`} w ! "y:f:,A�`, J..i 7 ? r ,.T - � e,�.,"+r„a r :_ @ " ,r' „ ene anel. alteration, or
,., .w;u 4a, .:.i » !!ar-;:�,i,,:: „ ?!".;:�'>.- „,.,;. ,`: ,:!” C .,- _ ..,. ; , ,,,,.,4,,,,,..t. extension. Describe: Paget 2
Business name: Johansen Electric Inc.
Address: 10948 SE Valley View Terr. Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Clackamas, OR 97015 Investigation per hour (I hrmin) 62.50 _
Phone: (503) 698 -3417 Fax: (503) 698 -2486 Industrial plant per hour 73.75
CCB Lic.: 51539 Electrical Lie.' 3-243 S . . Lic.: 2053S Subtotal
� 10 ; i � 53.50
Suprv. Electrician signature, required: Plan review (25% of pwmit fee)
Print name: Date: 11/1/05 state surcharge (8% of permit fee) - 4.28
` ` , � TOTAL PERMIT FEE 57.78
Authorized signature: / /� rib permit appbcatloo eiplrn if a permit is not obhined wtthia 180
days after n hu been acc epted as compkte
Print name: / l., . D ate : 11/1/05 • Fee methodology set by Tri-County Building Industry Service Board 1 •• Number of inspections pa pewit allowed.
i:2uildjo Pn iMBLC- PermfApp.doe 12/03 4 0- 461ST(IWNVCOMAVEB
,,
CITY OF TIGARD •-. .
BUILDING DIVISION PERMIT #: ELC2005 -00860
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/212006
Phone: (503) 639 -4171 / ,w�' �'+
Inspection Requests (24 Hrs.): (503) 639 -4175 `'I ..
INSPECTION WORKSHEET FOR DATE: 12/1/2005 TIME: 7:08AM PAGE: 39
SITE ADDRESS: 12909 SW 68TH PKWY 400 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: SPEC SPACE
DESCRIPTION: TI
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 -624 -6300
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503698-3417
Inspection Request Scheduled For: Date: 12/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
19 Electrical final 022749 -01 503704 -1534 N
Corrections /Comments /Instructions:
(_'
1
TXPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C - Date: /2/ / Phone #: (503) 718- 2 Y 6
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC200500860
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/2/2005
Phone: (503) 639 -4171 4,04).0,1A
Inspection Requests (24 Hrs.): (503) 639 -4175 L
INSPECTION WORKSHEET FOR DATE: 11/30/2005 TIME: 7:09AM PAGE: 60
SITE ADDRESS: 12909 SW 66TH PKWY 400 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: SPEC SPACE
DESCRIPTION: TI
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 - 6246300
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503 698 - 3417
Inspection Request Scheduled For: Date: 11/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 022639 -01 503 -704 -1534 N
Corrections /Comments /Instructions: Irah • b"0% q b9 5241.
11 AM vJAi'f fO miN•
11',11 Ann A( �
Gvi k,
o is - ' t w4
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
!1`q FAIL RCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N (W M'
Date: till St Phone #: (503) 718- 2.444